NEW YORK (Reuters Health) - The encouraging results of a health initiative in the border city of El Paso, Texas, suggest that school-based health programs can succeed in encouraging children to exercise more and eat a healthier diet.

In most of the schools involved in the program, the time children spent in moderate to vigorous physical activity increased and the fat in school meals and sodium in school breakfasts decreased, according to a report in the August issue of the journal Health Education and Behavior.

There is still room for improvement, since not all of the schools met or maintained the healthy goals, but the results show that a program can improve children's health, according to one of the study's authors, Dr. Karen J. Coleman of the University of Texas at El Paso.

"You need faith, tenacity, community money and mouths, and good, clear data, and you can change the health of your community," Coleman told Reuters Health.

It is no secret that eating a healthy diet and exercising regularly can go a long way toward preventing heart disease, diabetes and other diseases, but most Americans are still missing the boat when it comes to personal fitness. Though Americans of all backgrounds have expanding waistlines, physical inactivity and obesity are "especially prevalent" among Hispanics, according to Coleman and her co-author, Dr. Edward M. Heath, of Utah State University in Logan.

With the aim of preventing later health problems by promoting exercise and a healthy diet among schoolchildren, the non-profit Paso del Norte Health Foundation funded the implementation of a health program called Coordinated Approach to Child Health (CATCH) in elementary schools in the El Paso area. In national studies, children participating in CATCH programs became more physically active and ate healthier diets.

The CATCH program has several components, but the El Paso program focused on physical education classes and school meals. The program started in the El Paso region in 1997 and included 83 area schools during the 2000-2001 school year.

To evaluate the impact of CATCH in El Paso, Coleman and Heath compared 20 elementary schools in the program with 4 schools that did not participate in the program. The study findings suggest that CATCH has encouraged healthier lifestyles in children in the El Paso area, although the results were somewhat inconsistent.

In most of the schools in the CATCH program, children's levels of physical activity increased during the first year of the program. However, in many of the schools, levels of physical activity dropped somewhat after the first year of the program.

Results of the drive to make school meals healthier were somewhat mixed, the report indicates. All schools seemed to meet the goal for breakfast--less than 30% of calories from fat and sodium below 1,000 milligrams. Schools had a harder time reaching the nutritional goals for lunch, however.

Though the study identified several improvements, Coleman and Heath caution that due to a lack of baseline information from some of the schools, they cannot prove that the CATCH program was responsible for the improvements. They note, however, that in schools not enrolled in the program, physical activity did not increase and the percentage of fat in school lunches did.

According to Coleman, taking a "cookie-cutter" approach to improving the health of schoolchildren is a "recipe for failure."

"School-wide interventions must be built from the ground up," Coleman said, "with special considerations for the culture of the school, not just the community in which the schools are located."

Coleman said that the success so far in the El Paso program is due to a combination of "sheer determination," private funding and "a few dedicated, overworked souls."

Besides the CATCH program, Coleman said that the El Paso community has taken other steps to improve the health of its schoolchildren. For example, she said that the city's largest school district turned down a $20 million contract that would have granted a soft drink company exclusive rights to supply the school system for 10 years. Instead, the school district and the beverage company agreed on a 2-year contract to provide water, 100% fruit juice and nonfat milk in all elementary andmiddle schools, according to Coleman.

SOURCE: Health Education and Behavior 2002;29:444-460.

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